[Code of Federal Regulations]

[Title 42, Volume 2]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR422.52]



[Page 977]

 

                         TITLE 42--PUBLIC HEALTH

 

                    CHAPTER IV--CENTERS FOR MEDICARE

                          & MEDICAID SERVICES,

                        DEPARTMENT OF HEALTH AND

                             HUMAN SERVICES

 

PART 422_MEDICARE ADVANTAGE PROGRAM--Table of Contents

 

             Subpart B_Eligibility, Election, and Enrollment

 

Sec. 422.52  Eligibility to elect an MA plan for special needs 

individuals.



    (a) General rule. In order to elect a specialized MA plan for a 

special needs individual (Special Needs MA plan, or SNP), the individual 

must meet the eligibility requirements specified in this section.

    (b) Basic eligibility requirements. Except as provided in paragraph 

(c) of this section, to be eligible to elect an SNP, an individual must:

    (1) Meet the definition of a special needs individual, as defined at 

Sec. 422.2;

    (2) Meet the eligibility requirements for that specific SNP; and

    (3) Be eligible to elect an MA plan under Sec. 422.50.

    (c) Exception to Sec. 422.50. CMS may waive Sec. 422.50(a)(2) 

concerning the exclusion of persons with ESRD.

    (d) Deeming continued eligibility. If an SNP determines that the 

enrollee no longer meets the eligibility criteria, but can reasonably be 

expected to again meet that criteria within a 6-month period, the 

enrollee is deemed to continue to be eligible for the MA plan for a 

period of not less than 30 days but not to exceed 6 months.

    (e) Restricting Enrollment. An SNP must restrict future enrollment 

to only special needs individuals as established under Sec. 422.2.

    (f) Exceptions. (1) As specified in Sec. 422.4, CMS may designate 

certain MA plans that disproportionately serve special needs 

individuals, as defined in Sec. 422.2 as SNPs.

    (2) Individuals already enrolled in an MA plan that CMS subsequently 

designates as an SNP may continue to be enrolled in the plan and may not 

be involuntarily disenrolled because they do not meet the definition of 

special needs individuals in Sec. 422.2.



[70 FR 4716, Jan. 28, 2005]